Headlines about "Medicare and Medicaid"
Gathered from the web by the editors at BenefitsLink.com.
[Opinion] How Ideas from Private Industry Help Combat Medicare Fraud, Waste and Abuse
"While the financial services industry has had prolonged success combating fraudulent transactions with technology-based solutions, it is important to realize that the rate of improper payments was perhaps at most 0.1-0.2 percent. The estimated level of improper payments in Medicare is 50-100 times higher. This level of endemic fraud, waste, and abuse is best addressed through incentives for all stakeholders, implementation of multiple, differentiated and decentralized solutions, and establishment of stretch goals for combating improper payments." (Marco Huesch and Robert Szczerba in Health Affairs)
Trends in Medigap Coverage and Enrollment, 2012
"In 2012, most Medicare beneficiaries with a standardized Medigap policy had Plan F (53 percent). Plan C, the second most popular plan, had 13 percent of the Medigap standardized plan market. Plans F and C cover 100 percent of the deductibles and coinsurance not covered by Medicare.... Enrollment in Plan N, which includes cost-sharing of up to $20 for physician office visits and up to $50 for certain emergency room visits (waived in certain circumstances), grew by 35 percent between December 2011 and December 2012, and was the most popular of the newer standardized plans." (America's Health Insurance Plans)
When Medicare Launched, Nobody Had Any Clue Whether It Would Work
"Medicare is, these days, an incredibly popular program. Americans overwhelmingly oppose cutting it. No politician would consider repealing it. Most think providing health insurance to all Americans over 65 is worth the both the trouble and the cost. This was not always true. Back in 1966, as Medicare was just about to launch, nobody knew whether the new program would provide benefits to millions or fail completely. Sound familiar?" (The Washington Post)
Feds Make It Easier for States to Enroll Poor Under Health Law
"Allowing adults to stay in the program when their income changes is a 'big deal,' said Alan Weil, executive director for the National Academy for State Health Policy. He said it was likely to reduce the large number of people churning in and out of the program, which interferes with their ability to get care. Thirty-two states now use this option for children." (Kaiser Health News)
[Official Guidance] Text of CMS Letter to State Medicaid Directors on Facilitating Medicaid Enrollment and Renewal in 2014 (PDF)
"This letter describes five specific targeted enrollment strategies and provides guidance for states interested in adopting them: [1] Implementing the early adoption of Modified Adjusted Gross Income-based rules; [2] Extending the Medicaid renewal period so that renewals that would otherwise occur during the first quarter of calendar year 2014 ... occur later; [3] Enrolling individuals into Medicaid based on Supplemental Nutrition Assistance Program (SNAP) eligibility; [4] Enrolling parents into Medicaid based on children's income eligibility; and [5] Adopting 12-month continuous eligibility for parents and other adults." (Centers for Medicare & Medicaid Services)
Two Insurers May See Surge in Medicare Advantage Enrollments
"Medicare Advantage plans for the elderly and disabled will swell to 21 million participants by fiscal 2023 from 14 million this year, the Congressional Budget Office said yesterday in its annual review of the federal budget. The CBO didn't explain the revision from its previous estimate that enrollment would fall to 11 million[.]" (Bloomberg)
[Official Guidance] Text of CMS Final Reg on Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare Prescription Drug Benefit Programs
"This final rule implements new medical loss ratio (MLR) requirements for the Medicare Advantage Program and the Medicare Prescription Drug Benefit Program established under the Patient Protection and Affordable Care Act.... For the most part, this final rule incorporates the provisions of the proposed rule." [118 pages, including a 50-page discussion of the comments submitted to CMS on the proposed rule.] (Centers for Medicare & Medicaid Services)
[Opinion] Text of Comments to CMS on Advance Notice of Methodological Changes for Calendar Year 2014 for Medicare Advantage Capitation Rates (PDF)
"Our comments relate solely to the proposal that Part D sponsors should require their network retail and mail pharmacies to obtain patient consent to deliver new or refill prescriptions prior to each delivery.... An alternative approach that strengthens protections for both Medicare beneficiaries and the Part D program would be to develop balanced, workable guidelines that require affirmative written or electronic consent when patients opt in to an automatic refill program and the opportunity for beneficiaries to opt out of an automatic refill program entirely or for any particular medication." (American Benefits Council)
Report Predicts Drop in Health Care Costs During Retirement
"For only the second time since [2002], Fidelity Investments reported ... that the average projected cost of health care expenses for retirees has gone down. A 65-year-old couple exiting the workforce in 2013 is estimated to need $220,000 to cover health care costs throughout their retirement, an 8% decrease from last year's $240,000.... Fidelity Benefits Consulting ... does not include nursing home costs in its projections, which apply to retirees with traditional Medicare insurance coverage." (Employee Benefit News)
California Counties Still Not Prepared to Offer Expanded Mental Health Care
"When the final phase of the new federal health care law starts in January of next year, more California residents than ever before will be able to seek help for problems ranging from depression, anxiety, and addiction to schizophrenia and bipolar disorder. But mental health providers in the state's Central Valley are unprepared for an influx of thousands of patients. State and county officials remain in the planning phases, even though new patients will be able to access these services in less than nine months." (HealthyCal)
[Opinion] More Analysis of the Oregon Medicaid Experiment
"[B]ased on statistically insignificant effects of coverage from the Oregon Experiment: (1) The effects that are closest to statistical significance are that coverage would increase the rate of smoking and damage the cardiovascular prognosis of sick people; (2) the best estimated net effect on total population cardiovascular health is extraordinarily tiny; (3) this effect would be achieved by making the sick sicker, while very slightly improving the health of already healthy people; and (4) this effect is almost certainly unattractive on a risk-adjusted basis." (John Goodman's Health Policy Blog)
Marilyn Tavenner Confirmed as Medicaid and Medicare Chief
"Fierce disagreements over health policy had made confirmation difficult for any nominee for the Medicare job. Ms. Tavenner, a nurse who worked for more than two decades at the Hospital Corporation of America, will be the first Senate-confirmed administrator since Dr. Mark B. McClellan stepped down in October 2006." (The New York Times)
[Opinion] Why 'Medicare-For-All' Is Not the Answer
"The argument for universal Medicare basically comes down to three key claims: (1) Medicare gets lower prices; (2) Medicare's administrative costs are lower; and (3) greater spending does not mean better health. Each of these deserves closer attention." (Dana Goldman and Adam Leive in Health Affairs)
Continuity of Medicaid Coverage (PDF)
"While it is intuitive to believe that the cost of Medicaid services for a person enrolled 12 months would be twice as high as a person enrolled six months, this analysis shows that this is not the case. The cost of 12 months of coverage ($3,996) is only 42 percent more than the cost for six months ($2,814)." (Association for Community Affiliated Plans)
[Opinion] Why Medicare Won't Cover You Overseas
"While allowing seniors to receive Medicare coverage abroad is not a cure-all to this fiscal crisis, the potential savings could be significant. Health care costs for a procedure overseas can be less than half of the cost of the exact same procedure performed in the United States, saving both Medicare and the retiree money." (U.S.News and World Report)
Private Insurers' Medicare Advantage Plans Cost Medicare an Extra $34.1 Billion in 2012
"[T]he private insurance companies that participate in Medicare under the Medicare Advantage program and its predecessors have cost the publicly funded program for the elderly and disabled an extra $282.6 billion since 1985, most of it over the past eight years. In 2012 alone, private insurers were overpaid $34.1 billion." (Physicians for a National Health Program)
Shifting Seniors to Private Plans Already Has Cost Medicare $282.6 Billion
"Medicare adopted a risk-adjustment scheme in 2004, but this has not curbed private plans' ability to game the payment system. This has added $122.5 billion to Medicare's costs since 2004.... In total ... Medicare has overpaid private insurers by $282.6 billion since 1985. Risk adjustment does not work in for-profit MA plans, which have a financial incentive, the data, and the ingenuity to game whatever system Medicare devises." (Physicians for a National Health Program)
GAO Reports that Alternative Measures Could Be Used to Allocate Medicaid Funding More Equitably
"GAO's analysis shows that measures of the demand for services, geographic cost differences, and state resources can be combined in various ways to provide a basis for allocating Medicaid funds more equitably among states." (U.S. Government Accountability Office)
[Opinion] Oregon's Medicaid Lottery: A Participant's View
"Q: How did lacking insurance affect your medical care? A: ... You're always telling them, 'No, no, no, this is the only thing I want.' ... You have this resistance all the time, because doctors and nurses look at you with these big soft eyes and say, 'But it would be so important to know your level of cardiac health, I'm really concerned. I'm sure the doctor there will work out something and make payment arrangements.' And it sounds so good and you do it and it never works out. The discount isn't there or you fill out something wrong and all of a sudden you have a $300 bill in collections. So you have to make sure none of that happens to you." (Kaiser Health News)
Hospital Billing Varies Widely -- But Quality Has Nothing To Do With It
"[The hospital] charges have almost nothing to do with what hospitals get paid. Medicare doesn't pay charges, Medicaid doesn't pay charges, and health plans don't pay charges. Every one of these entities gets a discount from charges, and those discounts are highly diverse as well, creating another layer of irrationality in the pricing scheme. Worst of all, the only patients expected to pay these nonsensically variant hospital charges are the unfortunate people who have no coverage at all." (Leah Binder in Forbes)
Medicaid Planning Is Alive and Well
"The Deficit Reduction Act of 2005 with its five-year look-back put a big dent in Medicaid planning for long-term care. But there are still plenty of options for preserving income and retaining assets." (Morningstar Advisor)
Group Health Plans Ruled Primary Plans When Coordinating With Medicare Advantage Plans
"Group health plans ... should confirm they are properly coordinating benefits with Medicare Advantage organizations (MAOs) to avoid a private cause of action for double damages to recover amounts under the Medicare Secondary Payer Act (MSP Act) in light of the U.S. Supreme Court's denial of certiorari on an appeal of the Third Circuit's decision in In Re Avandia Marketing Sales Practices GlaxoSmithKline LLC v. Human Medical Plans, Inc. (Glaxo). The Supreme Court's decision ... lets stand a Third Circuit decision that the private right of action provision in the MSP Act ... gives Humana a private cause of action as a primary plan against GSK to recover the double damage award." (Solutions Law Press)
GAO Recommends Enhancements for Medicaid Improper Payments Reporting and Related Corrective Action Monitoring
"The objectives of this report were to determine the extent to which (1) CMS's methodology for estimating Medicaid improper payments follows OMB guidance and produces reasonable national and state-level estimates and (2) corrective action plans have been developed to reduce Medicaid payment error rates and whether these plans address the types of payment errors identified.... GAO is making four recommendations to help improve CMS's reporting of estimated Medicaid improper payments and its related corrective action process." (U.S. Government Accountability Office)
[Opinion] Some Thoughts on Medicare Reform Options
"At a time when our politicians have decided to open discussions on reducing government spending in Medicare, it likely is no coincidence that this cluster of articles on ways of reforming the financing of Medicare appears in the leading journal of health policy -- Health Affairs. But beware; the thrust of most of the articles should raise our concerns." (Physicians for a National Health Program)
[Opinion] Proposed Medicaid Per Capita Cap Would Shift Costs to States and Undermine Key Part of Health Reform
"A per capita cap would jeopardize successful implementation of the [ACA]. The law's Medicaid expansion is a good financial deal for states; the federal government will pay nearly all of the cost. But a per capita cap designed to produce federal savings would require states to bear more -- possibly a great deal more -- of the expansion's cost. States would almost certainly receive less federal funding for each newly eligible beneficiary than under current law." (Center on Budget and Policy Priorities)
Hospital Billing Varies Wildly, According to CMS Data
"Government officials said that some of the variation might reflect the fact that some patients were sicker or required longer hospitalization. Nonetheless, the data is likely to intensify a long debate over the methods that hospitals use to determine their charges." (The New York Times)
One Hospital Charges $8,000 While Another Charges $38,000
"Experts attribute the disparities to a health system that can set prices with impunity because consumers rarely see them -- and rarely shop for discounts. Although the government has collected this information for years, it was housed in a bulky database that researchers had to pay to access." (The Washington Post)
[Official Guidance] CMS Releases Medicare Provider Charge Data
"[CMS is releasing data] that show significant variation across the country and within communities in what hospitals charge for common inpatient services ... [including] hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges.... Users will be able to make comparisons between the amount charged by individual hospitals within local markets, and nationwide, for services that might be furnished in connection with a particular inpatient stay. Data are being made available in Microsoft Excel (.xlsx) format and comma separated values (.csv) format." (Centers for Medicare & Medicaid Services)
[Opinion] Almost Any Health Cost Is Catastrophic If You're Poor
"Those who benefit from Medicaid have low incomes. What does catastrophic coverage mean for them? How much out of pocket spending should we ask of a severely ill American living below or near the poverty line? And while if you have more skin in the game you would likely reduce spending and wasteful care, you would also reduce valuable, health-protective care, since studies have shown that patients cannot tell the difference." (The New York Times)
Strategies Could Curb Medicare Costs But Could Drive Seniors Out
"Researchers found that adding a means-tested premium for Medicare Part A would cut spending by 2.4 percent, while increasing the eligibility age would trim spending by 7.2 percent. The largest savings would come from a move to a premium support or voucher plan, which could cut spending by up to 24 percent if pegged to growth in the consumer price index ... But each of the approaches would cause some seniors to lose Medicare coverage." (RAND Corporation)
[Opinion] What Health Insurance Doesn't Do
"if it turns out that health insurance is useful mostly because it averts financial catastrophe ... then the new health care law looks vulnerable to two interconnected critiques.... [I]f the benefit of health insurance is mostly or exclusively financial, then shouldn't health insurance policies work more like normal insurance? ... If the marginal dollar of health care coverage doesn't deliver better health, isn't this a place where policy makers should be stingy, while looking for more direct ways to improve the prospects of the working poor?" (The New York Times)
[Opinion] Oregon Medicaid Study Is Devastating News for Obamacare Backers
"[I]f Medicaid doesn't make people any healthier than they were when they were uninsured, that implies that the entire ObamaCare program could be one huge waste of money. (Actually, the results weren't a complete disappointment. There was less depression among the Medicaid enrollees; they reported that they were a tiny bit happier; and among those who had out-of-pocket expenses, they spent about $215 less out of pocket each year. But, remember, we could have reimbursed out-of-pocket spending and spent far less than was actually spent on this program.)" (John Goodman's Health Policy Blog)
The 'Medicare Essential' Option: Promoting Better Care and Curbing Spending Growth
"Researchers propose a new coverage option for Medicare beneficiaries that would provide comprehensive benefits, protection from catastrophic costs, and incentives for choosing high-quality, high-value care. Combining hospital, physician, and prescription drug coverage, the 'Medicare Essential' option could save $180 billion in national health spending in the next decade while also improving care." (The Commonwealth Fund)
Florida Rejects Medicaid Expansion, Leaves 1 Million Uninsured
"Unless the Republican-controlled legislature comes back for a special session later this year ... Florida will not expand Medicaid in 2014. In Florida, where one in five non-elderly residents lack insurance coverage, the consequences are especially large: An estimated 1.3 million Floridians were expected to gain coverage through the the Medicaid expansion. About a quarter of those people ... would still be eligible for tax subsidies on the health insurance exchange." (The Washington Post)
[Opinion] The Benefits of Medicaid Expansion: A Reply to the Heritage Foundation
"[W]hile a Medicaid expansion would increase [Ohio's] Medicaid costs by about $2.5 billion from 2014 through 2022, it would also save [the state] $1.5 billion by reducing state spending on current programs in favor of the largely federally financed expansion.... Medicaid expansion would create more than 27,000 Ohio jobs, reduce the number of uninsured by more than 450,000, cut health costs for employers and residents by $285 million and $1.1 billion, respectively, and lessen budget shortfalls facing Ohio's counties." (Timothy Jost in Health Affairs)
[Opinion] Why the Oregon Medicaid Study Strengthens -- Not Weakens -- Case to Expand Medicaid
"In addition to reporting the important positive results, the researchers were careful to explain their findings' limitations, including small sample sizes that prevented them from concluding that some trends were statistically significant." (Center on Budget and Policy Priorities)
[Opinion] You Can Lead a Horse to Water ...
"Most of the commentary [on the Oregon Medicaid study] has been shocked that there was no statistically significant improvement in health measures between people who were enrolled in Medicaid and those who were not.... Before we even get to the outcomes question is the issue of whether very many people want to have insurance coverage, even when it is totally free." (John Goodman's Health Policy Blog)
[Opinion] Here's What the Oregon Medicaid Study Really Said
"We don't know if the results speak to the health care you get through all health insurance or just Medicaid or if they're just an artifact of the study's timeframe and sample size. We don't know if different ways of designing insurance programs would lead to radically different care outcomes ... And so we don't know whether we're seeing a problem in Medicaid, an inconvenient truth about medical care, or something else." (Ezra Klein in The Washington Post)
State-By-State: A Progress Report on Medicaid Expansion
"As of May 1, 16 states plus the District of Columbia have approved the expansion or are headed in that direction, 27 have rejected it or about to and seven states could still go either way.... With uncertainty about those plans and legislative battles still unfolding in a number of states, it's not yet known how many states will expand their Medicaid programs come Jan. 1, when the [ACA] is set to take effect. [A chart provides] up-to-date look at where each state and the District of Columbia stand at the moment." (Kaiser Health News)
Republicans Propose Medicaid Caps
"Under the plan ... the federal government's share of each state's Medicaid payments would be determined by the type of patients who use Medicaid. Separate funding pools would be created for the four populations Medicaid serves: elderly beneficiaries, disabled people, children and adults. The proposal would cap per-person spending within each category." (The Hill)
Oregon Study: Medicaid Had 'No Significant Effect' On Health Outcomes vs. Being Uninsured
"The result calls into question the $450 billion a year we spend on Medicaid, and the fact that Obamacare throws 11 million more Americans into this broken program." (Avik Roy, in Forbes)
[Opinion] Shocker: Oregon Health Study Shows No Significant Health Impacts from Joining Medicaid
"Either people with insurance are doing an okay job of getting treatment for all the major chronic diseases -- which is startling, because as you may recall one of the main reasons that we needed Obamacare was all the poor uninsured people who can't control their blood pressure or diabetes. Or that the treatment Medicaid patients get for their chronic diseases doesn't do them much good." (The Daily Beast)
[Opinion] Twelve Reasons Why States Should Not Expand Medicaid
"[1] Medicaid harms the poor.... [2] Medicaid spending will explode.... [3] Medicaid's access problems will get worse as more doctors drop out.... [4] States will be exposed to higher Medicaid costs when Washington recalculates its matching payments.... [5] Medicaid expansion will worsen the cycle of dependence and harm the economy.... [6] Claims about job creation are exaggerated.... [7] Medicaid crowds out private coverage.... [8] Medicaid raises premiums for those with private insurance.... [9] Medicaid's undercompensated care is a bigger problem than providing uncompensated care for the uninsured.... [10] Expanding Medicaid will expose states to increased risks of fraud and waste.... [11] By rejecting the Medicaid expansion, states encourage others to do the same, fueling the spending cycle.... [12] States should demand more control and flexibility to expand coverage their own way." (Galen Institute)
[Opinion] Everything You Need to Know About the Groundbreaking Oregon Health Study
"The Oregon Medicaid experiment is a unicorn. A beautiful, rare unicorn.... It's the first randomized-controlled trial testing any kind of health insurance against being uninsured -- period.... The problem with the Oregon study ... is we don't really know what we're learning. It's not clear, for instance, if the results are applicable to all health insurance, to all Medicaid insurance, or just to Oregon's Medicaid program." (The Washington Post)
Medicaid Reduces Financial Hardship, Doesn't Quickly Improve Physical Health
"The new data could come to bear in states' decisions on whether to expand Medicaid to cover millions of low-income Americans in 2014, as the Affordable Care Act allows. Many states with large uninsured populations, most notably Florida and Ohio, have yet to decide whether to move forward." (The Washington Post)
Health Care Use Rises With Expanded Medicaid
"[The Oregon Health Study] found that those who gained Medicaid coverage spent more on health care, making more visits to doctors and trips to the hospital. But the study suggests that Medicaid coverage did not make those adults much healthier, at least within the two-year time frame of the research, judging by their blood pressure, blood sugar and other measures.... Health economists anticipate that new enrollees to the Medicaid program will swell the country's health spending costs by hundreds of billions of dollars over time." (The New York Times)
How Medicaid Affects Adult Health
"Enrollment in Medicaid helps lower-income Americans overcome depression, get proper treatment for diabetes, and avoid catastrophic medical bills, but does not appear to reduce the prevalence of diabetes, high blood pressure and high cholesterol ... [Researchers] found about a 30 percent decline in the rate of depression among people on Medicaid; an increase in people being diagnosed with, and treated for, diabetes; and increases in doctor visits, use of preventative care, and prescription drugs. They also found that Medicaid reduced, by about 80 percent, the chance of a person having catastrophic out-of-pocket medical expenses, defined as spending 30 percent of one's annual income on health care." (MITnews)
[Opinion] Oregon Study Throws a Stop Sign in Front of Obamacare's Medicaid Expansion
"The Oregon Health Insurance Experiment ... may be the most important study ever conducted on health insurance. Oregon officials randomly assigned thousands of low-income Medicaid applicants -- basically, the most vulnerable portion of the group that would receive coverage under ObamaCare's Medicaid expansion -- either to receive Medicaid coverage, or nothing.... Consistent with lackluster results from the first year, the OHIE's second-year results found no evidence that Medicaid improves the physical health of enrollees." (Cato Institute)
Text of GAO Report on Activities, Staffing and Funding for the CMS Center for Strategic Planning (PDF)
"CSP assists individual offices and centers in developing strategic plans for their units, leads the agency's senior-level strategic planning meetings, and is helping to develop a centralized approach to monitor the implementation of CMS's agency-wide strategic plan. As of January 2013, CSP had 11 staff and it had $1.9 million in funds obligated for fiscal year 2012. Staff size and funding for CSP's most recent fiscal year represent a decrease compared to prior years, in part because CSP's activities have been narrowed in scope since the office was established in 2010[.]" (U.S. Government Accountability Office)
Seven Choices Medicare Advantage Plans Will Need To Make In Order To Survive
"In the short term, MA plans will need to take action in order to survive the initial impact, such as optimizing 2014 plan benefits, reprioritizing star focus areas, and even exiting selected geographies. In the long term, however, more will be needed as Medicare becomes increasingly consumer-centric. In this market, MA plans must develop a fundamentally different business model that allows them to preserve margins in a future environment of rate parity with Medicare [fee-for-service] costs while still offering equal or better aggregate benefits." (Timothy Jost in Health Affairs)
[Opinion] HHS to End the Only Demo that Actually Worked
"If you go down the list of about 7,500 tasks that Medicare pays doctors to perform, you'll discover that reducing hospitalization just isn't there.... [If Health Quality Partners'] activities were replicated nationwide we would save about $122 billion a year.... So what is the Department of Health and Human Services doing about this fascinating experiment? It's going to close it down." (John Goodman's Health Policy Blog)
Medicare's Income-Based Premiums Can Affect Retirement Savings
"What's the difference between $107,000 and $107,001? Answer: $974.40, at least that's how much more that $1 in income will raise ... annual Medicare premiums for Part B and Part D in 2013.... The standard Part B premium is set to equal 25 percent of projected program costs, with general revenues funding the other 75 percent. Higher-income enrollees pay a higher percentage of Part B costs. The percentage rises as income rises, with premium amounts that range from 35 percent to 80 percent of the value of Part B coverage." (Financial Advisor)
Health Care Experts Propose $1 Trillion in Savings
"The proposals are comprehensive, addressing everything from Medicare Advantage to medical liability reform to licensing barriers. They promise $300 billion in net federal savings over 10 years. In Medicare, the group would phase out fee-for-service care over 10 years by promoting comprehensive payment organizations. They would also enact an out-of-pocket cap on expenses. The paper places special emphasis on cost and quality transparency, urging universal standards that would translate between private and public health insurance." (The Hill)
[Opinion] Medicare Releases a 1,424-Page Rule That's Actually Really Interesting!
"It's one of the first things you'll learn as a health policy wonk in Washington: Medicare releases its most important, most crucial regulations around 5 p.m. on Friday, dashing happy hour hopes across the city. Last Friday was no exception. Medicare released a 1,424-page rule that tells Medicare hospitals what they will get paid in 2014. The table of contents alone stretches on for 37 pages. Still, if you want to understand how the country's largest health insurance plan wants to change how it pays for health care, this is the exact place to look." (The Washington Post)
If This Was a Pill, You'd Do Anything to Get It
Very extensive analysis of the effects of chronic care on the healthcare system, and efforts to improve outcomes while containing costs. "With chronic illnesses like diabetes and heart disease you don't get better, or at least not quickly. They don't require cures so much as management.... This ... is the core truth, and core problem, of today's medical system: Its successes have changed the problems, but the health-care system hasn't kept up." (The Washington Post)
[Guidance Overview] CMS Proposed Rule Would Establish Powerful New Measures for Uncovering and Combating Medicare Fraud
"In addition to reducing high-risk enrollments, these changes greatly enhance incentives to whistleblowers and could sharply increase the number of tips that CMS receives regarding potential fraud. Taken together, these changes could significantly boost CMS's ability to detect and recover fraudulent payments." (Vorys, Sater, Seymour and Pease LLP)
[Opinion] Text of Comments to CMS on Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare Prescription Drug Benefit Programs (PDF)
"CMS has made a concerted effort , in developing regulations implementing Section 1857(e)(4) of the Social Security Act, to closely mirror the regulations implementing the commercial health insurance MLR provisions enacted under Section 2718 of the Public Health Service Act. Consistency between the Medicare MLR regulation and the commercial MLR regulation is an appropriate approach . Our comments focus on a few areas in which further clarification would be helpful or for which we wanted to provide some additional thoughts based on our experience with the commercial MLR regulation." (Medical Loss Ratio Regulation Work Group, American Academy of Actuaries)
[Opinion] 21st Century Health Care Options for the States
"The reasons why states should NOT participate in Obamacare's Medicaid expansion are well-documented ... Less well known ... are the innovative programs states have utilized over the past several years to modernize and enhance their health sectors, expanding coverage and improving quality of care while lowering costs.... [T]hese policy solutions seek to transform Medicaid using market incentives to create a health system that works for patients." (Galen Institute)
Sen. Harkin Has a Hold on Obama's Medicare Pick -- What Gives?
"The Senate Finance Committee unanimously supported her nomination. She has the support of multiple former Medicare heads; one compared her to Mother Teresa. Even House Majority Leader Eric Cantor (R-Va.), who does not like Obamacare one bit, really likes Marilyn Tavenner. Enter, Sen. Tom Harkin, the Iowa Democrat who has put a hold on Tavenner's nomination. Harkin is demanding, according to [a] spokeswoman ..., 'An ongoing conversation about the future of the prevention fund.'" (The Washington Post)
Senate Committee Gives Go-Ahead for Tavenner Appointment as CMS Administrator
"With a Senate committee vote in her favor Tuesday morning, Marilyn Tavenner moved a step closer to becoming the first confirmed administrator that [CMS] has had in 7 years.... 'She has been an effective leader during her tenure as the acting administrator for CMS ...,' AMA President Jeremy Lazarus, MD, said ... '[D]uring this important time for the Medicare and Medicaid programs it is important to have a strong, well-qualified leader who is able to build consensus.'" (MedPage Today)
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